Adults with Mycobacterium tuberculosis infection and pre-diabetes have increased levels of QuantiFERON interferon-gamma responses

• Type of Material: Article
• Authors: Matthew Magee, Emory University; Susanna Trost, Emory University; Argita D. Salindri, Georgia State University; Genet Amere, Georgia State University; Cheryl Day, Emory University; Neel Gandhi, Emory University
• Language: English
• Date: 2020-05-01
• Publisher: Churchill Livingstone
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2020 Elsevier Ltd. All rights reserved.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.tube.2020.101935
• Title of Journal or Parent Work: Tuberculosis
• Volume: 122
• Start Page: 101935
• End Page: 101935
• Grant/Funding Information: This work was supported by the National Institute of Allergy and Infectious Diseases at the National Institutes of Health [grant numbers R03AI133172 to M.J.M. and K24AI114444 to N.R.G.].
• Keywords: Release assays; Tuberculosis infection; Immunology; Respiratory System; Microbiology; Disease; Life Sciences & Biomedicine; Risk; Science & Technology; Interferon-gamma; Susceptibility; Diabetes mellitus
• Research Categories: Health Sciences, Immunology; Health Sciences, Epidemiology; Biology, Microbiology; Health Sciences, Public Health

Abstract

Background: Diabetes is associated with increased prevalence of TB infection in the US. We assessed associations between diabetes and interferon-gamma (IFN-γ) TB antigen response among adults with TB infection using US representative data. Methods: National Health and Nutrition Examination (NHANES) participants >19 years from 2011–2012 with positive QuantiFERON®-TB Gold-In-Tube (QFT) results were eligible. Diabetes was defined by combination of self-report and glycated hemoglobin (HbA1c). Quantitative IFN-γ TB antigen was classified as high (≥10 IU/mL), intermediate (1.01–9.99 IU/mL), or low (0.35–1.00 IU/mL). Analyses accounted for NHANES weighted design. Results: Among NHANES participants >19 years, n=513 had positive QFT (5.9%). Among those with positive QFT, diabetes prevalence was 22.2% and pre-diabetes was 25.9%. Overall, 16.7% of positive QFT participants had high IFN-γ TB antigen levels including 21.7% among those with diabetes, 20.8% among those with pre-diabetes, and 12.6% among euglycemic participants. In adjusted analyses, high IFN-γ TB antigen response was more common among those with pre-diabetes (aOR 1.9, 95%CI 1.0, 3.6) compared to euglycemic participants. Conclusion: Higher antigen responses may reflect immunopathy consistent with an exaggerated inflammatory but ineffectual response to TB or a reflection of more Mtb replication in participants with pre-diabetes or diabetes.